Tuesday, 2 October 2012

Welsh Government 'on the back' of health board

NHS consultation - lacking vision and ambition

A leading paediatrician has admitted that the Welsh Government has been "on the back" Betsi Cadwaladr health board for the past 12 months over planned cuts to local health services.
Today's consultation in Wrecsam with managers from Betsi Cadwaladr University Health Board focussed almost exclusively on the health board's plan to move neonatal intensive care from North Wales to Arrowe Park on the Wirral.
There was also concern about the failings of the Accident & Emergency department in the Maelor and how that would be made worse by closing community minor injury units. What's worrying is that management appeared oblivious to the train crash that is A&E in Wrecsam - with its long delays and multiple ambulances routinely forced to wait outside.
But the meat of the debate was regarding neonatal intensive care. We now know, thanks to a Freedom of Information request to Arrowe Park's Trust, the extent of the debate between the two health bodies. The debate has centred around care for the most seriously ill babies (20-25 according to the internal e-mails, 36 according to Betsi Cadwaladr's consultation).
Arrowe Park have seen an opportunity to charge £1240 per day per baby for this service (whereas they currently charge £1024). Quite why they need to charge an additional 20% isn't made clear but putting your eggs in the English NHS privatisation basket isn't the cleverest strategy for a board looking for £64 million in savings.
The clinician present, Dr Patrick Harrington, admitted that he had made the case for the retention of neonatal intensive care to the board but was overruled because that would be "too ambitious".
Shame on them for lacking ambition and vision to develop our health service locally. Because there is a real opportunity to reverse the steady slide of specialist services from North Wales to the soon-to-be privatised English NHS and all its attendant PFI problems. North Staffs is the hospital where major trauma patients from North Wales are now being sent.
Back in Arrowe Park, the Daily Post revealed that internal e-mails shows there are only four Intensive Care cots at present with the capacity to double that to eight. That's two fewer than are currently available in Glan Clwyd and Wrecsam.

There is another way.

Wrecsam Maelor could retain its Level 3 Intensive Care cots, which will be needed anyway because capacity is expected to rise by at least 20% due to bringing 500 births a year back to Wales from Chester. This alone will save the Trust £2m a year. The fact that both Chester and Shrewsbury hospitals now only offer Level 2 care (High Dependency) means there is an opportunity to offer an alternative for mothers from just across the border who don't want to travel to Telford and further afield in England.
For once, let's see cross-border health services working in our direction.
This could be enhanced by attaching a research unit that would help solve clinical recruitment problems in terms of offering research facilities and training at the highest level. The current plan means that doctors would be unable to complete their training in North Wales because the neonatal services would not be here.
As the NHS in England moves towards a privatised future, many doctors may well be attracted to somewhere still committed to the traditions of the NHS.
The finances for such an scheme can be met by slicing away at the top-heavy management at Betsi Cadwaladr, reducing the spin doctors and avoiding the rising costs of obtaining services in England.

It's a suggestion, something that needs to be costed and assessed. But if this consultation is to be meaningful these alternatives have to be in the mix.

And the Welsh Government has got to explain why it's "on the back" of the NHS board demanding changes.

Currently 500 women from Wales (mainly Flintshire) have their babies in the Countess of Chester hospital at a cost to the Welsh NHS of £2m. These will in future come to Wrecsam or Glan Clwyd as will babies from North Powys currently going to Shrewsbury.

So instead of going to the nearest hospital, all women from Deeside will have to make a cross country journey, which is double the distance, to deliver a baby - what could possibly go wrong? What happened to the right to choose? What next shipping poorly kids to Cardiff instead of Alder Hey?

What people need to understand is that the model for the delivery of care in Betsi Cadwaladr Health Board is that of the urban model, instead of the rural model. This has many implications for the people of south Gwynedd and any other very rural area....

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